CLC Lecture Series
From Care to Lifestyle: A City for all Ages
URA Function Hall, Singapore
13 September 2012
The traditional paradigm of infrastructure
for the elderly regards them as needing
care, with “good care” being defined as a
medical, well-designed facility.
On 13 September 2012, as part of the
CLC Lecture Series, Dr Emi Kiyota broke
this convention by asking the audience of
developers, city planners and policy
makers to look at the elderly as assets,
and to build a place which gives them a
good lifestyle, integrated with the rest of
the community.
The environmental gerontologist spoke
on the benefits of the concept she
founded after spending months living with
elderly folks in a long-term care facility for
senior citizens. While the staff at the
centre did all they could to take care of
the elderly residents, Dr Kiyota found that
many of them were still lonely, bored and
experienced
helplessness
and
desperation.
“I know many of you are designers, but I tell my designer friends, don’t overdesign.
Leave some imperfections, leave the users of the community to decide what they
need,” she said.
She cites, for example, the bamboo poles which act as handrails for a home for the
elderly in Japan. These poles are not as hardy as metal rails, and need to be replaced
every six months. But they blend in better with the natural surroundings of the home –
and they involve volunteers and the community.
She contrasted this with a series of words about how care for the aged is usually
regarded as a “Nursing home”, “Elderly facility”, “Day care centre”. “Now, how many of
you are excited about your old age?” she asked, to laughter from the audience.
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Integrating senior citizens into society
Ageing is an issue that many cities in the world face today – how to cater to the
swelling ranks of elderly people in their midst. The UN Economic and Social
Commission for Asia and the Pacific estimates that in 2050, 4 in 10 people in Asia will
be above the age of 60, compared to just 1 in 10 now. The swelling silver group will
also translate into higher health care costs for governments in these countries,
estimated to double and even triple their health wage bills.
In Singapore, the Government estimates that there will be 600,000 people above the
age of 65 by 2020 and this would mean needing to recruit four times the number of
people currently working in the eldercare sector. By 2015 it will become the country
with the fourth highest number of old people in the world, where the average age of its
population will exceed 60 by 2050.
Given the preoccupation with the increase in public spending, it is no wonder that
when a city and its people talk about taking care of the elderly within the community,
the view is that senior citizens need care - be it physical or psychological. Providing
that care for them has traditionally meant providing good and affordable health care
through adequate medical and elderly-care facilities. However, Dr Kiyota urged the
audience to regard senior citizens as assets who can be tapped on for their wisdom,
rather than as liabilities who strain the public health care system.
Given this, a community should be built to include the elderly, rather than segregating
them from the other age groups. It should tap on their experience, values and needs
and integrate multi-generations all into one eco-system.
Showing case studies of different communities with the elderly, she used the word
“Ibasho” to capture this. Loosely translated from Japanese, Ibasho means "a place
where you can feel like yourself". The concept thrives on the belief that even as a
person ages, he or she is able to feel useful and valued.
On the importance of infrastructure, she noted that the integration of the elderly into
the community required planning which took into account, not just design and
engineering principles, but also the thinking and tastes of the users.
Even the most luxurious, well-furnished and fully-equipped centre will not make the
elderly people happy if they have neither community nor value.
Noting that senior citizens in Africa living in grass huts who got to play with their
grandchildren every day were happier than those living in swanky old folks' home, Dr
Kiyota believes that the elderly should be allowed to live more "authentic" lives when
they grow old.
While senior citizens should be realistic about changes that need to be made to their
lifestyles due to ageing, they should not be cut off from their usual way of life.
In her talk, Dr Kiyota focused on how infrastructure can support inclusive ageing.
A Japanese cafe with the ‘Ibasho’ Concept
Showing slides of the aftermath of the massive tsunami that wrecked the eastern coast
of Japan, she revealed that many families were left homeless and lived in temporary
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housing projects. The senior citizens who survived the huge waves were found to be
more depressed over the new living conditions as they felt there was no way to rebuild
their lives.
The Ibasho concept was applied in the Iwate province, which was one of the worst-hit
areas. An Ibasho cafe was set up beside a temporary housing-community site in the
city of Ofunato and serves as a place for people of all ages in the community to meet
and discuss ideas over some simple food and drinks. At these meetings, the whole
community discusses community issues and plan, tapping on the senior citizens’
insights to shape the community they live in.
The project involved
senior citizens working
together with others in
their community from
across all age groups
to set up and run the
cafe. The seniors also
run a service where
they help each other
with daily chores such
as grocery shopping
and baby-sitting. The
cafe also has a corner
set aside where elderly
volunteers
conduct
basic health checks on
other senior citizens.
It provides a chance for the elderly to play an active role in the cafe and allowed them
to contribute what they could, thus highlighting their abilities, rather than their
disabilities, and making them feel useful. The cafe adopts the theme of "Wisdom of the
Elders" to reinforce the values of respecting the knowledge and insights that come with
years of experience and interactions among different generations.
This notion of integration clearly resonated with the audience who brought this up
during the question and answer session. One participant, who worked in Shanghai for
eight years, related how he saw older people enjoy themselves while taking care of
their grandchildren in the playground.
Exercise facilities for older people were also constructed beside this playground. In
contrast, he observed that many older folks whom he saw in nursing homes within the
same vicinity were disgruntled and often complained about their children.
“Older people like their grandchildren more than their children. Why? Because they are
empowered by their grandchildren,” he said, urging the design committee to take
integrated living seriously.
This is not always easy as one participant noted, with the recent “not in my backyard”
issue, where some Singaporeans protested the building of nursing homes near their
flats.
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Ms
Charlotte
Beck,
Senior Director of the
Elderly and Disability
Group at the Ministry of
Community Development,
who moderated the Q & A
session, said that she
was “more optimistic”
about the issue.
Recounting what she saw
overseas, she said that
book stores, cafes and a
gym were built into
facilities for the elderly so
that others who lived in
the area visited the facility
too.
“It was a very natural traffic flow…not contrived at all,” she said, contrasting this with
the “volunteer week” sort of activities which sees the obligatory Chinese dances during
the Chinese New Year.
Another issue raised was the high proportion of foreigners who serve as caregivers for
the elderly in Singapore. This was contrasted with the case in Japan where many were
locals, and hence had little communication or cultural barriers.
Replying, Dr Kiyota said frankly: “Japan is in denial.” Like many other countries, such
as Singapore and America, it too needs immigrants to help, she said, but it just has not
come to terms with doing so.
Citing her work in Washington, where many caregivers were not locals, she agrees
that some immigrants were not able to read or speak English well. But the “sense of
compassion” she argued, was most important, and is a universal language.
Mixing Ages
Wrapping up, Dr Kiyota urged the design community to take up the challenge of
thinking more for the benefits of the elderly. Some questions that should be considered
include: How do you fit senior citizens into a limited space? How do you put them in a
place that they would like to live in?
If society can embrace this notion of integrated living, it is not only the elderly who
benefits. Society as a whole benefits because it is low cost, encourages volunteerism
and builds social capital within the community.
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About the Speaker
Dr Emi Kiyota, an environmental gerontologist and organisational culture change
expert, focuses on initiatives to improve the quality of the built environment for longterm care and ageing services.
Emi is a consultant to numerous age-friendly design projects for senior housing,
hospitals, and clinical-care centres in the United States, Europe, Asia and Africa. Dr
Kiyota is also a frequent speaker on these issues to audiences of both academics and
practitioners. In addition to her consultant work on quality improvement in the built
environment for long-term care and ageing services, Emi holds great concern for the
similar needs of elders in the developing world. To this end, Emi and a group of likeminded colleagues have created a new not-for-profit, international organisation entitled
Ibasho, embodying the Japanese concept of "a place where one feels at home being
oneself.“
Dr Kiyota is awarded a Bellagio Fellowship for a one-month residency on an
'Innovative Response to Global Aging' from the Rockefeller Foundation. She plans to
further develop her idea on creating a process for community planning that embraces
and engages elders for the benefit of all.
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